Pt id: (b)(6); on (b)(6) 2013, he received a right total hip arthroplasty.The implant was a stryker secur-fit v40 132 degree neck angle #8 stem, x3 40 mm id, 60 mm titanium, with 40 mm +4 cobalt chrome heat, and 2 cancellous screws.He also has a left hip replacement with a depuy replica stem with a 36 mm + 1.5 cobalt chrome head implanted on (b)(6) 2014.On (b)(6) 2017, this whole blood cobalt level was 7.6 mcg/l and urine cobalt level was 12 mcg/l.On (b)(6) 2017, his whole blood cobalt level was 6.8 mcg/l and urine cobalt level was 24.2 mcg/l.On (b)(6) 2017, his whole blood cobalt level was 5.2 mcg/l and urine cobalt level was 15.0 mcg/l.On (b)(6) 2017, cobalt level right hip joint fluid aspirate ws 1,000 mcg/l and chromium level was 56 mcg/l.Cobalt level of left hip joint fluid aspirate ws 4.2 mcg/l, and chromium level ws 4.8 mcg/l.The cobalt / chromium levels of the hip joint fluid aspirate confirmed that the right stryker hip was generating more metal than the left hip.Pt had cardiac valve replacement in 2009 followed by pacemaker implantation.He developed sleep apnea in 2008.Since then, he progressively developed fatigue.In 2017, rest tremor of the hands and blurry vision were also noted.In 2017, he noted intermittent swelling and pain in the right hip.Metal suppression ct scan off the pelvis and bilateral hips on (b)(6) 2017, notable for some residual cystic osteolysis of the left peri-acetabular area.He does have more artifact on average on the left side because of the chrome cobalt stem.Right side shows no significant fluid collection or soft tissue changes and no osteolysis of the prosthetic left hip has some cystic osteolysis about the central fixation screw of the cup, and he may have some ballooning of the lateral right hip capsule consistent with a pseudotumor.He began taking n-acetyl cystein around (b)(6) 2017 for cobalt chelation.This was only partially effective.Fdg pet brain with neuro q analysis showed a pt of hypometabolism compatible with early arthroplastic cobalt encephalopathy.On (b)(6) 2018, the right hip was revised.Revision involved exchange of the crco head and x3 poly for a delta option ceramic 36mm +4 hed nd a zimmer constrained liner cemented into existing shell.The old stem was sound and was in about 20 degrees of anteversion.The trunnion of the stem and the head bore showed gross corrosion and internal corrosion.The poly was in good repair.The posterior capsule was attenuated but salvageable, anterior capsule was moderately thickened but salvageable abduction tendons were only slightly affected and did not require repair and the trochanteric bursa was affected with attrition of the tensor fascia femoris at the greater trochanter.His right hip joint fluid cobalt level was 930 mcg/l and chromium level was 240 mcg/l.On (b)(6) 2020, about 2 years post revision of the right hip, his whole blood cobalt level is less than 0.5 mcg/l and his urine cobalt level is 0.5 mcg/l.He has retained the depuy mop hip on the left side with cocr parts.Fda safety report id# (b)(4).
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